Provider Demographics
NPI:1619770542
Name:KEEL, ANJUANISE L
Entity type:Individual
Prefix:
First Name:ANJUANISE
Middle Name:L
Last Name:KEEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OAK SPRINGS CV
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-4341
Mailing Address - Country:US
Mailing Address - Phone:901-949-5383
Mailing Address - Fax:
Practice Address - Street 1:4190 MEADOW RIDGE TRL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-1304
Practice Address - Country:US
Practice Address - Phone:901-949-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN071874338172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver